高血脂对腹膜透析患者的残余肾功能影响

目的：观察高血脂对连续性不卧床腹膜透析（CAPD）患者的残余肾功能（RRF）的作用。方法：定期监测共72例CAPD患者血脂成分及残余肾功能,根据血脂的变化将患者分为胆固醇（TC）增高组、三酰甘油（TG）增高组及二者均增高组与TC、TG正常组,比较各组残余肾功能变化。结果：CAPD治疗初期残余肾功能无明显变化（P〉0.05）。第12月时,TC增高组RRF较同组透析初月时下降（P〈0.05）。TG增高组及TC、TG均增高组的RRF分别与透析初月时同组RRF比较显著下降（P〈0.001）。第18月时3个血脂增高组RRF与TC、TG组比较均有下降（P〈0.05）。RRF下降数值与TC（r=0.234,P〈0.05）、TG（r=0.528,P〈0.05）均呈正相关。结论：CAPD患者的RRF随着透析时间的延长而降低。高血脂与RRF改变值有正相关性。     

肾衰宁胶囊对维持性腹膜透析患者残余肾功能的影响

腹膜透析是目前终末期肾脏病常用的肾脏替代治疗手段之一,血流动力学稳定,较血液透析具有更优的保护残余肾功能(RRF)的价值[1]。维持一定的RRF对于保证透析的充分性、减少透析并发症的发生、延长腹透时间、节省治疗费用等方面有着十分重要的意义[2],因此积极有效地提高腹膜透析患者RRF水平越来越受到临床重视。祖国医学历史悠久,在治疗慢性肾脏病方面具有其独特的优势,研究证实肾衰宁胶囊对改善肾脏纤维化,延缓肾功能进展具有一定的作用。本研究观察了肾衰宁胶囊对维持性腹膜透析患者RRF的影响。     

残余肾功能对腹膜透析患者营养状况影响的临床研究

目的：前瞻性观察长期持续性非卧床腹膜透析（CAPD）患的营养状况,探讨残余肾功能对营养状况的影响。方法：采用常规处方透析,留取尿液、腹透液,并抽血检测生化、血脂及蛋白营养指标,计算残余肾功能（RRF）、KT／V值、肌酐清除率（Ccr)、单位透析剂量（PV／S）及蛋白质分解率（PCR）,评估每日蛋白质摄入量（DPI)。结果：RRF与KT／V、Ccr及残余尿量呈正相关,（分别r=0.56、0．83及0．80）,与透析时间、透析超滤量呈负相关（分别r=-0.41、0．33）,与PV／S无关。A组（RRF＜3ml/min)患Ccr、KT／V及血浆前白蛋白（PA）、视黄醇结合蛋白（RBP）、转铁蛋白（Tf)明显低于B组（RRF≥3ml/min),但PCR高于B组。然而,A、B两组间Alb、TG及TC却无明显差别。结论：RRF与腹膜透析充分性密切相关,并影响腹透患的营养状况,根据RRF下降程度及时调整透析剂量及方案,是预防CAPD患营养不良发生的最主要手段。     

腹膜透析初透剂量对患者残余肾功能的影响

目的 探讨腹膜透析（腹透）初透剂量对患者残余肾功能的影响。 方法 追踪观察我院3个月内连续门诊随访的178例开始腹透的患者,测定24 h尿量。根据透析第1、3个月尿量的变化分为少尿组（LU,97例）、尿量减少组（DU,19例）、尿量正常组（NU,62例）,记录并分析其透析剂量、腹透液葡萄糖含量、超滤量、尿素清除指数（Kt/V）、体质量、水肿程度及尿量变化等的相关性。 结果 3组患者的年龄和性别比例差异无统计学意义。透析1个月后,DU组的体质量和水肿程度大于LU和NU组（P < 0.05）;腹透液总入量、腹透液葡萄糖含量、超滤量、残余肾尿素清除指数Kt/V（rKt/V）高于LU组,与NU组差异无统计学意义。透析3个月后,DU组的体质量和水肿程度有所下降（P < 0.05）,但仍高于LU和NU组（P < 0.05）;腹透液总入量、超滤量、尿量下降速度比LU组和NU组高（P < 0.05）;rKt/V 比腹透前显著下降（P < 0.05）。3组的血清白蛋白和tKt/V差异无统计学意义。 结论 开始腹透患者过度超滤可引起残余肾功能下降。对于有一定残余肾功能的患者要注意避免快速或过多超滤。     

腹膜透析残余肾功能的研究进展

本文简要阐述了腹膜透析患者残余肾功能降低的机制,腹膜透析对保护残余肾功能的优势,以及影响腹膜透析患者残余肾功能的相关因素与保护残余肾功能的方法.     

腹膜透析残余肾功能的研究进展

本文简要阐述了腹膜透析患者残余肾功能降低的机制,腹膜透析对保护残余肾功能的优势,以及影响腹膜透析患者残余肾功能的相关因素与保护残余肾功能的方法。     

残余肾功能与腹膜透析患者营养状况相关性的研究

主观全面营养评价（ＳＧＡ）［２］已被证实适用于中国腹膜透析患者［３,４］。为进一步明确腹膜透析（ＰＤ）患者残余肾功能对营养状况的影响,我们用ＳＧＡ评分和血清白蛋白浓度作为营养指标,分析透析剂量（ＫＴ／Ｖｕｒｅａ）、残余肾功能（ＲＲＦ）等因素与营养状况...     

腹膜透析致残余肾功能减退及其对策

残余肾功能 (RRF)与腹膜透析的透析充分性及预后密切相关。然而 ,腹透患者的RRF随透析时间延长会不可抗拒的丢失。其影响因素可能包括 :原发疾病的发展 ,透析液的生物不相容性反应 ,透析过程中不恰当超滤脱水致血流动力学改变 ,终末期肾病患者脂质代谢系乱等。合并腹膜炎时的炎性介质释放 ,也可引起肾毒性反应 ,导致残余肾组织的损害。另外在治疗腹透感染时不恰当的使用肾毒性药物也是加速RRF减退的重要因素。预防RRF减退的对策应包括 :积极治疗原发病 ,制定合理的腹膜透析方案 ,慎用肾毒性药物 ,有效的控制血压、降低血脂等。     

替米沙坦联合尿毒清对腹膜透析患者残余肾功能的影响

目的：探讨替米沙坦联合尿毒清颗粒在延缓腹膜透析患者残余肾功能（RRF）丢失的作用.方法：将入选的75例病情稳定的维持性腹膜透析患者随机分为替米沙坦联合尿毒清治疗组、替米沙坦组和对照组.定期检测3组的RRF、高敏C反应蛋白（hsCRP）、Kt/V、肌酐清除率（Ccr）、血钾,并记录尿量、血压情况.结果：研究结束时,3组患者RRF、尿量均显著下降,联合用药组较对照组及替米沙坦组RRF丢失延缓,尿量保持更好（P〈0.05）,且联合用药组较对照组及替米沙坦组hsCRP显著下降（P〈0.05）.结论：替米沙坦联合尿毒清颗粒能更好地延缓腹膜透析患者RRF的丢失,并改善其微炎症状态.     

腹膜透析患者残余肾功能与左心室质量的相关性分析

目的探讨腹膜透析患者残余肾功能与左心室质量及左心室质量指数的关系。方法选取我院接受持续不卧床腹膜透析治疗半年以上的慢性肾衰竭患者103例,将其根据残余肾肌酐清除率（Ccr）水平分为3组,A组31例：Cer为0～2ml·min-1·（1．73m2）-1;B组42例：Cer为2～4ml·min-1·（1．73m2）;C组30例：Ccr〉4ml·min-1·（1．73m2）-1。所有入选患者均检测残余肾Ccr、平均动脉压（MBP）、血钙、血磷、血清全段甲状旁腺素（iPTH）、左心室质量及左心室质量指数,并进行组间统计学分析。结果3组患者MBP和血钙水平差异无统计学意义（P〉0．05）;与A组相比,B组和C组患者血磷、钙磷乘积、iPTH、左心室质量及左心室质量指数降低（P〈0．01）;Pearson相关分析显示,Ccr与血磷（r=-0．384,P=0．000）、钙磷乘积（r=-0．344,P=0．000）及iPTH（r=-0．435,P=0．000）存在负相关关系;左心室质量及左心室质量指数与MBP（r=0．300,P=0．002;r=0．240,P=0．015）、血磷（r=0．332,P=0．001;r=0．241,P=0．014）、钙磷乘积（r=0．284,P=0．004;r=0．212,P=0．032）、iPTH（r=0．266,P=0．007;r=0．226,P=0．021）存在正相关关系。结论左心室质量及左心室质量指数增加与残余肾功能的丧失有一定的相关性,积极保护残余肾功能可以减少心血管疾病发生率和病死率。     

Effects of Rosiglitazone on Cardiac Function in CAPD Patients: A Tissue Doppler Study

Background. Insulin resistance was an independent predictor of cardiovascular mortality in uremic patients without diabetes. Rosiglitazone (ROS) improves insulin sensitivity in the liver, muscle, and adipose tissue. We prospectively investigated the effects of ROS on cardiac functions by standard (SDE) and tissue Doppler echocardiography (TDI) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods. A total of 24 CAPD patients (13 males, 11 females; mean age 42.2 ± 14.8 years) were included. Routine blood samples were examined. Left and right ventricular functions were assessed, and myocardial performance index (MPI) was calculated by SDE and TDI at baseline and after 12-month ROS therapy. Left and right atrial volumes were measured and indexed to body surface area. Results. When compared with baseline, after 12 months of ROS treatment, it was shown that early (E) and late (A) diastolic velocities of atrioventricular valves, E/A ratio, mitral E-wave deceleration time (DT), isovolumetric relaxation time (IVRT), and MPI were similar (p > 0.05). Also, no significant changes were detected in LV dimensions, LV mass index, LVEF, LA volume index, or RA volume index measured by SDE before and after ROS therapy (p > 0.05). Left and right ventricular function parameters measured by TDI including Sm, Em, Am, Em/Am ratio, E/Em ratio, and MPI were similar. Conclusion. It was found that there was no negative effect of long-term ROS therapy on cardiac functions measured by SDE and TDI in CAPD patients.     

Survey of Blood Lead and Plasma Aluminium Concentrations in Patients of a Renal Unit

Blood lead and plasma aluminium concentrations have been measuredin patients with end-stage chronic renal failure treated byhaemodialysis (HD) or by continuous ambulatory peritoneal dialysis(CAPD) and in a control group of non-dialysed patients withchronic renal failure (CRF). Data on a group of subjects withnormal renal function is included for comparison. We have foundsignificantly increased mean blood lead and plasma aluminiumconcentrations in all patients with chronic renal failure comparedto a group with normal renal function. All blood lead concentrations were within the accepted safeexposure range of less than 1.8 µmol/l (380 µg/l)).There were significant differences among the patient groups:home HD, 0.60±0.25 µmol/l (124±52 µg/l);hospital HD, 0.39±0.31 µmol/l (81±64 µg/l);CAPD, 0.32±0.17 µmol/l (66±35 µg/l);CRF, 0.38±0.20 µmol/l (79±41 µg/l);normal, 0.24±0.11 µmol/l (50±23 µg/l).Correction of the blood lead results for haemoglobin accentuatesthese differences (i.e. hospital HD, 4.61±3.25 nmol/g(0.96±0.67 µg/g); CRF, 3.05±1.46 nmol/g(0.63±0.30 µg/g); normal, 1.65±0.70 nmol/g(0.34±0.14 µg/g). Plasma aluminium concentrations show a similar pattern: homeHD, 1.09±0.70 µmol/l (29.4±18.9 µg/l);hospital HD, 0.81±0.58 µmol/l (21.9±15.7µg/l); CAPD, 0.34±0.34 µmol/l (9.2±9.2µg/l); CRF, 0.18±0.09 µmol/l (4.9±2.4µg/l); normal, 0.09±0.07 µmol/1 (2.4±1.9µg/l). The duration of dialysis treatment is an important determinantof metal accumulation: there is a significant positive correlationbetween the duration of dialysis treatment and both blood lead:haemoglobinratio (r=0.48, P<0.01) and plasma aluminium (r=0.61, P<0.01)concentrations. There is also a significant negative correlation(r= –0.59, P<0.01) between urine volume and plasmaaluminium for haemodialysis patients, but not for peritonealdialysis patients. Urine volume shows no relationship to bloodlead. Age has no effect on lead accumulation in any of the patientgroups, but there is a significant correlation of age to bloodlead in the normal renal function group (r=0.47, P<0.01).The effect of sex and hypertension on metal concentrations isalso discussed. It is considered probable that the dialysate is a major factorcontributing to the accumulation of both elements. The possiblelong-term clinical significance of these findings remains tobe determined.     

Long-Term Outcome of Continuous Ambulatory Peritoneal Dialysis (CAPD) Peritonitis: Surgery can be Avoided

INTRODUCTION

Continuous ambulatory peritoneal dialysis (CAPD) has become the preferred method of home dialysis for patients with end-stage renal failure. Peritonitis is a common and serious complication and requires prompt diagnosis and treatment. The aim of this study was to assess what proportion of patients with CAPD peritonitis that required surgical intervention for on-going sepsis or for peritonitis-related bowel obstruction.

PATIENTS AND METHODS

All patients presenting with a first episode of CAPD peritonitis during the 5-year period from 1994–1998 were identified from a prospectively maintained database. Data collected included patient demographics, details of peritonitis episodes and their treatment, and details of any surgical intervention undertaken.

RESULTS

A total of 500 episodes were identified in 168 patients of whom 162 had complete follow-up representing 488 peritonitis episodes. Sixty-three patients experienced one episode of peritonitis, 33 two episodes, 20 had three episodes, and 46 had more than three episodes. None of the patients underwent surgery either primarily or for complications of the infective episode. A total of 465 episodes were due to a single organism (95%) and the remainder were due to multiple organisms (5%). The most common causative organisms were Gram-positive cocci (308 episodes; 71%) followed by Gram-negative bacilli (106 episodes; 24%). In 55 patients (34%), the same organism was implicated in consecutive admissions. Patients with autosomal dominant polycystic kidney disease (ADPKD), whilst accounting for 12 of 169 (7%) patients in the cohort, experienced 23 of 125 (18.4%) episodes of peritonitis by Gram-negative cocci. Such infections were seen in 8 of 12 (66.7%) ADPKD patients and accounted for 23 of 40 (57.5%) infections experienced by the ADPKD patients.

CONCLUSIONS

Whilst CAPD peritonitis is a common problem in the renal failure population, with almost 100 episodes per year, it would appear that most episodes can be managed using intraperitoneal antibiotics without the need for surgical intervention.     

Laparoscopic repositioning of a continuous ambulatory peritoneal dialysis (CAPD) catheter

We describe a laparoscopic technique for relieving obstruction of a continuous ambulatory peritoneal dialysis (CAPD) catheter. Laparoscopic repositioning of the catheter and omentectomy obviated the need for laparotomy in a patient with end-stage renal disease.     

腹膜炎对CAPD患者腹膜小分子物质转运与超滤功能的影响

目的观察了腹透时间、腹膜炎对连续非卧床腹膜透析(CAPD)患者腹膜转运与超滤功能的影响.方法观察对象为1998年～2001年在我透析中心行CAPD患者101例,其中发生腹膜炎者12例,为观察组;无腹膜炎发作史者89例,为对照组.于开始腹透后第1、6、12、18、24月分别进行腹膜平衡实验(PET),用于评价腹膜的小分子溶质转运(D/Pcreat)及超滤能力(UF).结果在无腹膜炎发作史的89例患者中,其D/Pcreat比值随腹透的进行而逐渐缓慢上升,至12个月时达到最大值(0.65±0.05),与透析第1个月相比无显著性差异(0.61±0.06,P=0.065);在伴有腹膜炎发作史者,其D/Pcreat比值上升幅度较大,并于腹透的第12个月也达到高峰值(0.74±0.056),与对照组相比有显著性差异(P＜0.05);在开始CAPD后,所有患者超滤量(UF)随透析时间延长,呈快速下降过程,特别是在伴有腹膜炎发作史的患者更为明显.无腹膜炎发作史的患者于透析第18个月达到最低水平(351±48 ml),与透析第1个月相比有显著性差异(382±42 ml,P＜0.05),而伴有腹膜炎发作史的患者则于开始透析后的第12个月达最低水平(326±57 ml),两组的差别具有统计学意义(P＜0.05).经线性回归分析,累积腹膜炎发作时间与腹膜肌酐转运水平(D/Pcreat)呈明显正相关(r=0.83),与腹膜超滤量(UF)呈负相关(r=-0.75).结论以糖为基质的常规CAPD对腹膜转运功能与超滤功能具有一定的负面影响,而腹膜炎则明显加剧或恶化常规CAPD对腹膜功能的负面作用.因此,进一步提高CAPD技术与方法,降低腹膜炎发生率仍是肾科工作者所面临的主要问题之一.     

Remnant of vitelline duct causing intestinal obstruction after commencement of CAPD

A 64-year old Japanese man began to experience intermittent epigastralgia, nausea, and vomiting just after commencing continuous ambulatory peritoneal dialysis (CAPD). Fourteen months after commencing CAPD, he had an intestinal obstruction. Because enhanced radiographs of the small intestine revealed that the occluded site was near the umbilicus, it was suggested that a remnant of the vitelline duct had adhered to and occluded the small intestine. Conservative treatment for the intestinal obstruction was not effective, and laparotomy was then performed. During the laparotomy, the first finding was a remnant of ligament-like vitelline duct connecting the protruding umbilicus and the small intestine. The second finding was that the small intestine was twisted around the remnant of the ligament-like vitelline duct at an angle of about 180° and completely occluded the intestine. Before the patient commenced CAPD, the remnant of the vitelline duct was asymptomatic, but it became symptomatic and finally caused intestinal obstruction after he commenced CAPD. This clinical course strongly suggested that the cue for the bowel obstruction caused by the remnant was the commencement of CAPD. This is the first report, to our knowledge, mentioning the relationship between CAPD and a remnant of the vitelline duct. Received: January 5, 2000 / Accepted: March 30, 2000     

CAPD与CCPD对钙、磷和PTH转运的对比研究

目的:探讨持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)与持续循环腹膜透析(con-tinuous cyclic peritoneal dialysis,CCPD)对钙、磷、甲状旁腺激素(parathyroid hormone,PTH)及血肌酐、尿素氮转运的影响。方法:选择2010年1月～2012年12月在北京大学深圳医院腹透中心常规CAPD治疗透析不充分并伴继发性甲状旁腺功能亢进的腹透患者20例,行腹膜平衡试验(peritoneal equilibration test,PET)了解腹膜转运特性,并计算基础Kt/V,然后给予CCPD治疗10d,检测CCPD治疗前后血及腹透液肌酐、尿素氮、Ca2+、P3-、Ca×P、iPTH,记录患者每日超滤量和尿量;比较CAPD与CCPD两种透析模式对上述指标影响。结果:CCPD治疗10d后总Kt/V由基线的1.73±0.33升高至2.30±0.37(P<0.05),Ccr/w由(47.43±7.61)L·wk-1·1.73m-2升高(61.69±10.52)L·wk-1·1.73m-2(P<0.05);血磷由(2.39±0.52)mmol/L降至(2.03±0.43)mmol/L(P<0.01);钙磷乘积由(66.73±15.84)mg2/dl2降至(58.81±13.64)mg2/dl2(P<0.05);iPTH由(84.85±15.84)pmol/L降至(58.81±13.64)pmol/L,差异均有统计学意义(P<0.05)。结论:短期CCPD能增加腹膜对小分子毒素(Cr、BUN)的清除,提高Kt/V和CCr值,并能降低血磷、iPTH水平。